philippines blood safety program: needs assessment trip · the world health organization has made...

Philippines Blood Safety Program: Needs Assessment TripAdam Weiss MD1, Elizabeth Donegan MD1

1Department of Anesthesia and Perioperative Care, University of California, San Francisco

GLOBAL HEALTH

BACKGROUND

A safe, reliable blood supply is a key element of modern healthcare systems.

However, in many developing countries, including the Philippines, the blood supply

lacks both the safety and capacity provided by a fully volunteer blood supply.

Instead, replacement and remunerated donors comprise the majority of blood

collected for transfusion.

The World Health Organization has made blood transfusion safety a priority for

improving healthcare in the developing world. The five key elements of their plan

include:

• Voluntary donation of blood from low-risk populations

• Screening for transfusion transmitted infections

• Blood compatibility testing

• Blood component fractionation

• Reduction in unnecessary transfusions

PURPOSE

The Philippines Blood Safety Program is working with Ormoc City in Leyte,

Philippines to develop a regional blood system that builds on the community’s

existing resources, and that meets the World Health Organization’s goals. An initial

needs assessment trip was completed in August, 2015.

Needs assessment trip goals:

• Collect data on Leyte’s regional blood supply

• Learn about Ormoc City’s healthcare infrastructure

• Meet community organizations interested in philanthropy

• Build personal and industry connections that will facilitate the program

APPROACH

The Philippines Blood Safety Task Group, a multidisciplinary group of volunteers

from UCSF, was formed in order to plan and implement improvements to the

Ormoc City blood system. They teamed up with Global Healing, an East Bay non-

profit with expertise in developing blood systems.

Methods for assessing need:

• Remote data collection forms emailed to the five Ormoc City hospitals and

Ormoc Red Cross

• Face to face meetings with directors of each hospital, Ormoc Red Cross, Rotary

club, and Ormoc City government

• Tour each facility to better understand the process and limitations of the current

blood system

EASTERN VISAYAS REGION

The Philippines ranks 117 out of 187 countries in the UN Human Development

Ranking. In terms of healthcare, resources are severely limited as compared to the

United States and other developing countries.

HEALTH INDICATORS

Country USA Haiti Honduras Philippines

Birth rate (per 1,000 population) 13.4 26 26.1 24.2

Death rate (per 1,000 population) 8.15 8.8 4.5 4.92

Life expectancy (years) 78.9 63.1 73.8 68.7

Under-5 mortality rate (per 1,000 live births) 11 94 28 37

HIV prevalence (per 100,000 population) 5 15 3 14

TB prevalence 4.1 254 74 438

Incidence of malaria (per 100,000 population) N/A 13 1.5 1.3

Incidence of dengue N/A 0.9 6.1 145

Whole blood donations (per 1,000 populations) ≥30 <5 5-9.9 5-9.9

Percentage of voluntary, unpaid donations (%) 99-100 50-89.9 <25 50-89.9

Ormoc City’s population is 191,200 (second largest on Leyte). Its primary form of

commerce is agriculture. Principle crops are sugar cane, rice, and pineapple.

BLOOD SYSTEM IN ORMOC CITY

When patients require blood transfusions they must negotiate an antiquated

ordering and procurement system that requires them to personally, or via family,

pay for and pick up blood products from the Ormoc Red Cross. They must also

provide a replacement donor. This process often takes up to 24 hours, making

emergency blood for transfusions virtually unattainable.

150

100

50

100

20

100

190

40

78

10

0

50

100

150

200

OSPA-FMC Ormoc DistrictHospital

Doctor'sHospital

Gatchalian Women's andChildren's

Ormoc City Hospitals’ Bed Capacity

Total Capacity Average Census

3832

21

0

10

20

30

40

Ormoc Red Cross

Blood Product Costs ($ USD)

Whole Blood pRBC Platelet/FFP

73.6

26.4

Ormoc Red Cross Donor Types (%)

Replacement Volunteer

BLOOD TESTING AND SAFETY

There is limited blood testing, fractionation, and storage equipment scattered

across the six facilities. However, the frequent disrepair of these machines leaves

the overall blood system unreliable. Additionally, there is no antibody screening

available when patient’s have reactive cross-matches.

0.46

2.67

0.73 0.73

0.07

2.43

0.6 0.66

0

0.5

1

1.5

2

2.5

3

HIV Hepatitis B Hepatitis C Syphilis

Transfusion Transmitted Infection Screening* (%)

Screen Positive Seropositive

*Total # of Units Tested Annually at

Ormoc Red Cross = 6,530

CLINICAL BLOOD UTILIZATION

180

56

25 20

020406080

100120140160180200

OSPA-FMC OrmocDistrict

Hospital

Doctor'sHospital

Gatchalian

# of Transfused Units per Month

75

20

5

Products Transfused at Ormoc District Hospital (%)

Whole Blood pRBC Platelets/FFP

47

28

17

3 5

Transfusions by Department at Ormoc District Hospital (%)

Medicine OB/Gyn Surgery

Pediatrics Other

10

5

0

2

4

6

8

10

12

OSPA-FMC OrmocDistrict

Hospital

Discarded Products (%)

PROJECT GOALS

• Development of a robust volunteer donor program. Accomplished through

partnerships with local business and news media to increase awareness and

community involvement in blood donation drives.

• Improve the quality and safety of blood product preparation and

distribution. Accomplished by procurement and maintenance of blood banking

equipment. As well as development of standard operating procedures and

quality assurance programs.

• Decrease unnecessary transfusions through changing clinical practice.

Accomplished by hosting regional transfusion symposiums on rational

transfusion guidelines, and online modules with updates on clinical practice.

CONCLUSIONS

The destruction of Typhoon Haiyan

adversely affected Ormoc City’s

healthcare system. Now, we have

the opportunity to work with local

physicians, hospitals, and the Ormoc

Red Cross to develop and put in

place a functioning, model blood

system; one that also can be

replicated in other regions of the

Philippines. Support the Philippines

Blood Safety Program today!

PhilippinesBloodSafety.org

Support in part by grants from the Global Health Clinical Scholars Grant, Global Healing, and the Donegan Lab.

ACKNOWLEDGEMENTS

The Ormoc City healthcare community is comprised of one semi-private farmer’s

hospital, one public district hospital, three private hospitals, and the Ormoc Red

Cross blood bank.